No Longer Silent: Voices of 21st Century Nurses

By Australian College of Nursing

No longer silent: Voices of 21st century nurses is a celebration of the diversity of nursing practice in modern times.

 

It is a far cry from the Nightingale style of nursing Lucy Osburn brought to these shores more than 150 years ago. The authors featured in this book are very aware of nursing history as they celebrate the voices of nurses in the 21st century.

 

The chapters are written by nurses who have walked hospital corridors as well as advocating and fulfilling the roles of senior policy makers, nurse practitioners, nurse leaders, military nurses, nurse trailblazers and nurse academics. The professional nurse of today occupies wide-ranging professional roles.

• Language: English
• Publisher: Ocean Reeve Publishing
• Release date: Aug 20, 2023
• ISBN: 9781923061163

Book preview

Foreword

What does it mean to be a nurse in the 21st century? What is the role of our profession now and how will it evolve in the future? These are some of the key questions addressed in this collection from nurses, in their own voice, drawn from their own unique perspectives.

No Longer Silent: Voices of 21st Century Nurses highlights the extraordinary journey nursing has been on since it transferred into the Higher Education sector some thirty years ago, and the role of the Australian College of Nursing and its predecessor organisations in advocating for our profession.

Contributors to this book have invested a great deal of time and energy championing the profession and the Australian College of Nursing. They write passionately from personal experience, sharing their perspectives as frontline nurses, educators, researchers, managers and government representatives.

The voice of nurses isn’t one we are used to hearing. When a comment is required from the health system, all too often it’s not a nurse’s voice that is sought, but why not? We are the largest health profession in the country, with over 400,000 registered nurses working in Australia. We are trusted by the public; we have unique and valuable insights; we are capable of making a significant contribution to the discourse of health and wellbeing of people everywhere; and yet all too often, our voice remains unheard by society.

The mainstream discussion of health policy and development, health system design and improvements in health outcomes consistently fails to include the critical perspective of nurses. This needs to change.

This book is an exposé of the hardships and challenges, the rewards and successes of being a nurse in the 21st century. Leaders in our profession share their experiences as they contemplate the important questions facing our sector. Hopefully, the views they share with us will raise awareness of nursing’s journey and contribution.

No Longer Silent: Voices of 21st Century Nurses is a celebration of the extraordinary skills, experiences and dedication that nurses bring to communities. The contributors featured here are keenly aware of their place in nursing history, the struggles overcome before their time, and the advancements made through education, technology, research and advances in women’s participation in the workforce.

Nursing has progressed enormously from the Nightingale style of nursing that Lucy Osburn brought to Australia more than 150 years ago. Nursing today traverses a wide range of contemporary issues: sexism, workplace harassment, racism, industrial rights, regional and remote concerns, violence against women in the workplace, technology, politics and global pandemics. We do so through evidence-based practice, research and exerting influence on governments. Nursing and nurses are at the heart of every health and social issue.

Our profession is working to develop and expand in new and innovative ways, some of which are covered in this book; the use of nurse practitioners, recruiting more men into nursing, and nurse entrepreneurs in the areas of rural and regional health, mental health and the military.

We are living through an important turning point for our profession, as we strive to have the nursing perspective heard and respected; to ensure appropriate systems are in place to achieve better health outcomes for all. This book showcases just some of the many voices calling for nursing to take a rightful place in decision-making at the frontline, but also, in boardrooms and in government, everywhere that healthcare decisions are made.

Nurses bring to healthcare and society an understanding not only of the science but also, of the art of nursing. We bring to the table a perspective built on skills in complex decision-making and problem-solving, driven by constant learning and reflection, evolving and adapting to the needs of patients, consumers, clients and residents. We are the link between patients and families, often the healthcare professional closest to patients, and we are witnesses to the real impact of illness and disease on families.

No other healthcare profession brings this perspective.

By bringing together the voices of these extraordinary leaders in our profession, we are claiming space to be vocal and to claim our rightful place in history. We are revealing a contemporary understanding of nursing’s role in society, based on its achievements and potential.

We will no longer be silenced.

Christine Duffield

President ACN

List of Illustrations

Editorial

This book is a celebration. It celebrates a decade of growth and development of the Australian College of Nursing (ACN). Under the leadership and vision of the CEO, Kylie Ward, the ACN has not only nurtured nurses to give them a voice at the bedside, amongst migrants, the mentally ill, indigenous and remote communities but importantly at the table where health policy decisions are made.

This book celebrates the voices of nurses and nursing in the 21st century. The nurse authors who have written chapters for this book are representatives of the many nurses and midwives throughout Australia who daily go quietly about their work in caring for the health needs of the nation. Nurses accompany people from the moment of birth, throughout their life span, to the latter years of life and death.

This book is a call to action to define who we are as an Australian nursing profession—something the nursing profession has been attempting to do since the time of Lucy Osburn.¹ I think readers will either be surprised or challenged in reading this book for it gives an indication of the diversity of nursing practice today, although not every aspect of professional nursing practice has been included in this volume. Nurses fulfil many vital roles in the health care system like well-oiled cogs in a machine and because of this ubiquitousness nurses have often been observed in the background. It seems it is only in times of crisis like the COVID-19 pandemic or world wars that nurses are brought to the fore in the public gaze.

This book takes us deep into nursing, into the core of what it means to be a nurse today, and as such, is a readable text for the nurse in the present. It also provides the general community with an opportunity to increase their knowledge of the practice of nursing.

It is hoped that this book will highlight the role of the modern nurse in all its variations and bring the nursing profession from the shadows into the light of day. This is a myth-busting book about nursing. It will turn on its head some old concepts and ideals. Presented in the book are new ways of thinking and practising nursing—outdated ways of representing nursing have been overturned.

For those nurses who received their nursing education in the hospital system, these changes are remarkable. The adage, the good old days, does not resonate today, as time and socio-cultural ‘mores’ have changed since the 19th and 20th centuries and continue to evolve.

What is represented here is not just hospital nursing but nursing as it is practised in many different and varied settings outside the hospital: in the community, in the outback, in the mental health arena, among indigenous peoples and within migrant communities. Represented in these chapters are the nurse practitioner, the male nurse, the clinical research nurse, the perioperative nurse, nurse leaders, military nurses, nurse trailblazers and nurse academics.

Contributors

All the authors are experts in their field of nursing in Australia and have impressive academic qualifications. They have garnered their knowledge both from formal study and from practical nursing experience. As experts in their chosen field, many are also pioneers, or in the language of the ACN, trailblazers. They continue to apply their knowledge of nursing and their experience for the future health care of the nation.

Many of the chapters are authored by nurses who have themselves had a ‘desire to understand the past as a guide to the present and future action’.² Each author of a chapter is aware they are writing a nursing history that future generations can refer to as an interpretation of events and personalities in this era. At the same time, each author is aware of writing history that is relevant to current readers. Many have included personal observations or that of others providing some interpretation or analysis that enriches the account.

Adjunct Professor Kylie Ward, CEO of ACN, introduces the chapters in this book with her general perspective on nursing. She writes of her own personal journey as a CEO new to the role, leading the organisation to become the pre-eminent professional voice of nurses, especially in the areas of policy, strategic planning, leadership and career advancement. Her role, she writes, is to educate the media and the public about the power of the collective voice of nurses to shape health care and advance nursing.

Belynda Abbott writes about the COVID-19 pandemic providing an overview of the Australian response. She considers how the fault line in the ‘COVID X-ray’ exposes the nation’s healthcare systems, culture and policies.³ Belynda writes of the pandemic’s impact on individual nurses and the nursing profession. She suggests the changing and challenging effects COVID-19 will have on the nursing profession will be seen into the future.

Professor Michael Roche’s chapter is a personal account of his observations and experiences in mental health nursing. He considers the developments and innovations that are occurring in mental health nursing, today. He underscores the importance of mental health nurse-led programs and the challenge of engaging with the broader healthcare community.

Dr Lois Hamlin writes of the changes that have occurred in surgical and peri-operative nursing. She reveals the ever-changing and many new roles for the nurses who specialise in this field.

Ben Chiarella discusses his personal decision and journey to become a nurse. He also outlines not only the fault lines in health care due to the COVID-19 pandemic but the opportunities that will exist in nursing, for those willing to accept the challenge to advance their careers.

Dr Ruth De Souza considers nursing in diverse situations and, in general, finds nursing (as indeed the nation) wanting when it comes to the subject of racism. She examines how racism can impact nurses in Australia and how racism and whiteness are edifices of colonisation.

Professor Odette Best, a Goreng Goreng, Boonthamurra and Koomumberri, Yugambeh woman, nurse and nurse academic explores the history of First Nation nurses and their access to university education. Odette suggests this is a very modern history as she documents the historiography of First Nation nurses’ and midwives’ paths in the tertiary education sector.

Heather Keighley writes of her knowledge and experience working in rural and remote areas of Australia. She points out the positive and negative aspects of being a rural and remote nurse in the outback. Heather also discusses areas where the healthcare system is failing or has not delivered optimum outcomes and where improvements can and are being made.

Sonia Martin, a nurse trailblazer, was the recipient of the Health Minister’s Trailblazer and Innovator Award in 2021. This award, inaugurated by the ACN, recognises a nurse who has excelled in improving health care for patients and clients. Sonia discusses what it means to be a trailblazer. She left her secure nursing position to establish Sunny Street providing health care to vulnerable and disenfranchised people.

Christopher (Chris) O’Donnell courageously writes about the development of nurse practitioners and the need for a renewed way of thinking about this important nursing role. He relates the hindrances that have been faced and overcome and indeed still need to be addressed.

Group Captain Kathryn Stein provides a rare insight into Australian Defence Force nursing. She outlines how far this division of nursing has come in the past decades, the forerunners to this advancement, and her own journey as a Defence Force nurse.

Emeritus Professor R. Lynette Russell insightfully writes about nurses in the tertiary sector since the transfer of nursing into the higher education sector and the numerous roles nurses now perform in Academia.

I am indebted to the editorial advisory team for their assistance and advice: Emeritus Professor R. Lynette Russell, Professor Noeline Kyle, Marilyn Gendek, the ACN History Faculty Team and Dr Jane Roy (ACN Publications Manager). I would also thank Neil Haynes (ACN Chief Operating Officer) for his professional financial advice; Emeritus Professor Christine Duffield (ACN President) for writing the Foreword and Adjunct Professor Kylie Ward, CEO of ACN for providing guidance, advice and work behind the scenes in securing authors to write their respective chapters.

Conclusion

It is my hope that the ideas in this book might stimulate conversation and provoke you, the reader, to enlarge your mind and expand your vision to embrace the possibilities that embody the profession of nursing. It is also hoped that future readers of this book will look back on the era recorded to reference what nursing was like in the 21st century.

This publication, No Longer Silent: Voices of 21st Century Nurses, celebrates the 10th anniversary of the inauguration of the ACN in 2012. The book is a tribute to the role the ACN has played in supporting and encouraging Australian nurses to engage with their profession, to envisage possible career paths, and understand the full breadth of nursing and the career opportunities available to nurses today.

Nursing history tends to be circular: gains made in one era have had to be regained in another, sometimes with progress being made, and at other times, retrograde steps turn inwards or backwards. The authors and this editor recognise that while much has changed for the better there remain negative aspects in the profession and the provision of health care for many Australians. While this book celebrates ten years of ACN’s history it also celebrates nurses and nursing practice which continues to forge ahead to face the challenges that will continue to arise in the future.

Dr Lesley Potter

References

¹.Judith Godden, Lucy Osburn, a lady displaced: Florence Nightingale’s envoy to Australia (Sydney: Sydney University Press, 2006).

².Celia Davies (ed.), Rewriting Nursing History (London: Croom Helm Ltd., 1980) 15.

³.Julianne Schultz, The Idea of Australia: A search for the soul of the nation, (Sydney: Allen & Unwin, 2022) 9.

CHAPTER 1

A Personal Journey and Development of the Australian College of Nursing—Kylie Ward

The Australian College of Nursing (ACN) was formed in July 2012 following the unification of The College of Nursing (TCoN) and the Royal College of Nursing Australia (RCNA). With these predecessor organisations forming in 1949 there was plenty of history. Previous attempts to form one national peak organisation had been unsuccessful, costly and public. I had been a long-time member of TCoN and RCNA, since my early nursing career days, and in 2007, was honoured to be awarded Fellowship status of both. In 2009, I was elected to the Board of Directors of TCoN and proudly continued to be a member of the Unification Board. Once ACN was formed and a new board elected, I stepped away, proud of my small contribution. I had no idea that three years later I would be appointed as the second Chief Executive Officer of the Australian College of Nursing.

The mission of ACN in 2015 was ‘advancing nursing leadership to improve health outcomes’. Whilst sounding impressive, when talking to ACN employees at the time it was clear, most didn’t understand what that meant. Having been a long-time member and Fellow gave me a distinct advantage of having experienced the member (or consumer) perspective, coupled with almost all my friends and acquaintances being nurses and freely sharing their opinions of the College and what it was or was not offering them. I knew we had some work to do to gain traction amongst the profession, increase student and member numbers, build brand awareness and relevance. If we were to live our mission of advancing nurse leadership then it needed to be by more than offering leadership courses or defining leadership—we needed to be the leader. Armed with this knowledge, I spent many hours contemplating what this would look like and how it could be achieved. We had much work to do to honour the nurses of the past who had the vision to have a professional body, a professional voice and professional education opportunities.

To be the leader and role model for the profession I knew we had to be seen as influential. I relocated to Canberra to commence my CEO role but soon, I realised we had no presence in Parliament, amongst politicians, or insight into any national policy. I wasn’t even sure what we stood for. I set about establishing and building relationships with many stakeholders in and out of nursing to make our presence known.

Building a media presence

When I started at ACN in November 2015, I investigated the media analytics relating to how nursing was profiled in health media. Throughout my career, I had always been disappointed that the voice of nurses wasn’t heard in the same way as our medical colleagues. I felt we had something to say and should be heard, but there seemed to be a wall of deafening silence. The results I received for that year showed that of approximately 5,000 health media stories, less than 3% were from nursing organisations, and of that, 0.005% were from the Australian College of Nursing. We did not have the resources, in those early months, to hire media staff so I set about learning and understanding the beast that is media and how I could penetrate it to position ACN as an organisation that journalists should be contacting to get a broader view of health and clinical concerns.

I have believed for many years that nurses and the nursing profession should have a greater media presence and that communities and consumers would benefit from hearing nursing experts speak and respond to relevant health issues. My experience, over many years, had taught me that nursing got the greatest media presence through industrial action when we were fighting for our basic rights of pay equity and better conditions and if nurses threatened to strike media seemed to notice. This attention was important but what was lacking for me was our voice on clinical, health and professional issues. As I progressed in my role, I extended this to include social issues.

Finding our voice

I had to learn that the way we speak, as a profession and an industry, does not translate to what people want to hear, or in fact understand, as there is a lot of jargon, we use that does not translate. I also spent time understanding what was important to us as a profession. I have met thousands of impressive nurses throughout my career, and all of them had individual opinions on many different things, but what was our collective opinion and perspectives as a profession? What mattered to us and what did we want to share with others? What were our positions and how did we decide them?

I soon learned that if we produced high-quality work, that was making a stand, rather than being conservative or sitting on the fence, it got attention.

In the early days of my role, mainstream media was not interested in us and I struggled to make connections. They had not been socialised into hearing through the lens of the nursing profession and almost always referred to the AMA, Medical Colleges and individual medical experts. I received a lot of rejections and ‘Sorry, not interested’ comments as they could not understand our value to the public conversation. It was a challenge I personally accepted. I watched, listened, learned and devised a strategy to change the landscape to reteach journalists and influence politicians to get the access to consumers that the profession deserved. I was determined that influencing policy would be our ticket into this forum, and by May 2016, we had a major breakthrough.

Image 1: L-R: Emeritus Professor Christine Duffield, President of the ACN; Adjunct Professor Kathy Baker AM, former President of ACN; Malcolm Turnbull, 29th Prime Minister of Australia; Adjunct Professor Kylie Ward, CEO of ACN.

On 12 October 2016, at the inaugural Parliamentary Breakfast hosted by ACN in Parliament House, the then Prime Minister, the Honorable Malcolm Turnbull, launched our White Paper Nurses are Essential in Health and Aged Care Reform.¹ We also had current Health Ministers and Shadow Ministers speak, as well as the leader of the Greens, Senator Richard Di Natale. Staff from Parliament and Government attended as well as nurses who travelled from all parts of Australia to participate in this monumental event. Guests and politicians commented they had never seen such a lineup of speakers. I have since learned that usually only one, or maybe two, politicians would speak at an event like this, but I had never attended a Parliamentary Breakfast. With nothing to compare it to, I did what I thought the profession deserved, invited as many political leaders as possible to speak in case one or more said no, and it turned out to be the largest breakfast held in Parliament. We filled every seat and had people standing and a waiting list of nurses hoping to attend. A stream of camera crews followed the Prime Minister and we were showcased on ‘The Project’ on Channel 10 that night. It was a frenzied and exciting day as we made history and I will be forever grateful to the Prime Minister for being the first in Australia’s history to launch an ACN White Paper. His presence gave us the kudos we deserved and the attention we needed to be noticed by stakeholders.

Following months of rejections from mainstream media, I sought out other options and secured interviews with health media organisations. I knew ACN had to lead in this space through our own social media. Upon my commencement, the ACN Facebook page had 1,477 likes so I gave the team the challenge to reach 10,000 likes by Christmas 2016. We promoted a thought leadership series including a great variety of topics and were very proud when